If you think you have experienced a missed miscarriage, my heart goes out to you. The sad truth is this type of early pregnancy loss is common. Now, just how common is a missed miscarriage?
Actually, more common than you may think. The frequency of missed miscarriages is on the rise affecting about 15% of clinically recognized pregnancies.
It is important to be educated about your body and what you are experiencing. Read on to get all your questions about missed miscarriage symptoms and missed miscarriage treatment answered.
And remember, you are strong and resilient.
What is a missed miscarriage?
As the name suggests a missed miscarriage is a pregnancy loss that you “miss”. You don’t realize it is happening until after the fact. Other names for this type of loss include: missed abortion or silent miscarriage.
In a missed miscarriage, the embryo stops growing and the fetal heartbeat will stop. Yet, you may not experience any obvious signs of the loss because you have not visibly miscarried.
When do missed miscarriages usually happen?
Usually between 5 weeks and 12 weeks into the pregnancy. But they can happen as late as 20 weeks (which is the earliest a fetus can survive at birth). The 5 weeks are calculated from the last period day or your last menstrual period (LMP).
Sadly, you will likely not know you had a missed miscarriage until a routine ultrasound scan with your obstetrician (OB). This usually happens at your 12-week ultrasound or your 20-week ultrasound. And you may find yourself in complete shock.
Missed Miscarriage Symptoms
You may be wondering: What does a missed miscarriage look like? Well, a missed miscarriage happens silently, so there are very few visible signs.
But keep in mind that each woman and each pregnancy is different. It’s possible that you could experience common miscarriage symptoms like light vaginal bleeding or brownish discharge. Sometimes this is confused with implantation bleeding.
Okay, so there are often no visible signs of a missed miscarriage. But now you wonder: What does a missed miscarriage feel like?
Again, every pregnancy is different. In most cases, a missed miscarriage has no clear signs. When the fetus is no longer able to survive, your placenta could still release pregnancy hormones. This is a mean trick that makes your body think the pregnancy is progressing as normal.
Most women who have a silent miscarriage show no signs. Others may have some subtle warning signs:
- Mild cramping
- A decrease in pregnancy symptoms (like breast tenderness)
- A feeling that something is wrong with the pregnancy
- Brownish vaginal discharge
What causes a missed miscarriage?
If you are like most women, you will want to know what causes this type of loss and see if there’s anything you can do to prevent it.
Missed miscarriages are caused by three possible types of defects: the fetus, the uterus, or the placenta. Of these three types, chromosomal abnormalities in the fetus are the most common cause accounting for 50% of the miscarriages.
Diagnosing a Missed Miscarriage
How long can a missed miscarriage go unnoticed?
For a while! It is hard to self-diagnose this type of loss, so if you think you have had one, definitely see your OB right away.
As a pregnant woman, you may be experiencing so much uncertainty. But the more educated you are about your pregnancy and any potential issues, the more prepared you will be to make any difficult decisions.
How is a missed miscarriage diagnosed?
There are several ways that your doctor can confirm a missed miscarriage. And some are more reliable than others.
One method is a pelvic exam. Your OB will check the opening of the cervix. If a missed miscarriage has occurred, the cervix will be closed.
Another sign is low levels of human chorionic gonadotropin (hCG). A blood test will be able to show this.
You can also confirm your pregnancy with an early urine pregnancy test. If you experience any vaginal bleeding after a BFP, then it is probably a missed miscarriage.
A more reliable method is a transvaginal ultrasound. This involves inserting an imaging device into your vagina for a clearer view of the pelvic organs and fetal tissue. (Ouch, I know 🙁)
If you have had a silent miscarriage, the ultrasound will show tissues of conception in the uterus but no fetal heartbeat.
Even though an ultrasound scan is more reliable in confirming a missed miscarriage than a pelvic exam, there is a chance it could be inaccurate. How frustrating!
If you find yourself in this position, you should have a repeat ultrasound within one to two weeks after the first one. You want to be sure to avoid accidentally ending or ignoring a healthy pregnancy.
What conditions increase the risk of missed miscarriage?
Ugh, so many! It can be hard to determine the exact cause of the loss because there are so many factors.
Here are some common conditions that can increase the risk of missed miscarriage:
- A higher than average or lower than average body mass index (BMI)
- Mothers aged 30 years or older. Advanced maternal age has been proven to increase the risk of all types of first trimester loss with risks as high as 74% for women over age 40.
- Growth abnormalities (determined by mean gestational sac diameter and crown-rump length (mGSD-CRL))
- History of C-section, ectopic pregnancy, or recurrent miscarriage
- Exposure to pollutants like second-hand smoke, heavy metals, and phthalates
What to Do for a Missed Miscarriage
You may feel overwhelmed with grief, but knowing your options is one way you can keep a sense of empowerment after a loss.
There are three main paths that can be taken for missed miscarriage management: expectant, medical, and surgical. Keep reading below to educate yourself more about your options for treatment.
Expectant management: This approach to treating a missed miscarriage requires no medical intervention and involves cautiously monitoring missed miscarriage symptoms. This is the most common way to manage this loss.
61% of the women in a study who had a missed miscarriage had a “successful outcome” with expectant management. Successful? What the heck does that mean? This just means the uterine contents passed without medical intervention.
For 52% of those women, the passing of pregnancy tissue was complete within two weeks of the diagnosis. But it can take up to three to four weeks for some women to fully complete the loss.
Medical management: This approach to treating a missed miscarriage involves taking a pill called misoprostol. This pill helps the uterus pass any remaining pregnancy tissue within a few days. For the majority of women who choose this option, no extra steps are needed.
Surgical management: This is the least common treatment for a missed miscarriage. For some women though (like those prone to infection), it could be necessary.
In this procedure (a dilation and curettage), a surgical instrument is used to scrape or suction out the remaining pregnancy tissue from the uterine lining. This procedure is successful 99% of the time.
What happens if a missed miscarriage goes untreated?
Often a missed miscarriage resolves naturally. But if the fetal tissue doesn’t pass on its own, you may get an infection. In this case, you need to see your doctor. Like ASAP.
Signs of an infection include flu-like symptoms (fever, chills, severe pain, etc.) and heavy vaginal bleeding (bleeding that is even heavier than a particularly heavy period). If you are unsure if you are having complications, it is better to be safe than sorry. So get checked out just in case.
Will a missed miscarriage affect future pregnancies?
Not necessarily! Having a missed miscarriage doesn’t mean that you will experience a loss in future pregnancies. But you may have an underlying condition that increases your risk for future pregnancy complications or losses.
- After one loss: 20% chance
- After two losses: 28% chance
- After three or more losses: 43% chance
Some research suggests that you have a better chance of conceiving again within 6 months of the loss. Although the exact cause is unknown, it is believed that the enhanced growth-supporting capacity of the uterus and the increased blood volume and flow increase your chances of conception. Make sure to consult your doctor to see what the best option is for you though.
Before trying to conceive (TTC) after a loss, make sure you are mentally and physically ready. You may also want to keep tabs on your menstrual cycle by waiting for your period and tracking your ovulation.
How can you cope mentally with a missed miscarriage?
Pregnancy loss at any stage is traumatic. It is important to look after your mental health and your physical health. Know that you are not alone and it is not your fault.
Here are some ways you can help mentally process what you are going through:
- Talk to your partner or a close friend or family member for emotional support. Avoid suffering alone.
- Speak to a mental health professional. They can help you work through the loss and guide you through coping strategies.
- Find a support group for infant loss or pregnancy loss to get through this very stressful time. Join Inito’s Facebook group.
- If you work and you are not ready to go back, explore your options for returning to work.
- Take care of yourself and your body.
The American College of Obstetrics and Gynecologists, defines recurrent miscarriage as having two or more pregnancy losses.
What can you do to prevent recurrent loss?
It is difficult to know for sure what caused the fetal demise, but there are some tests you can get done. These can potentially help you prevent future complications and losses.
If your doctor can determine the cause of the loss, they may suggest certain treatment options.
Here are some ways to get more answers:
- A comprehensive physical exam
- A pelvic exam
- Blood tests (to check for issues with your immune system)
- Genetic testing (to see if you or your partner are carriers for any genetic abnormalities)
- Imaging of the uterus
Want to hear the good news?
Less than 5% of women have two miscarriages in a row, and 65% of women who experience recurrent pregnancy loss (RPL), go on to have a healthy pregnancy.
Other Types of Miscarriages
A missed miscarriage is just one type of early pregnancy loss. Here are other types you should know about:
- Chemical pregnancy: this is when the egg is fertilized but fails to properly implant into the lining of the uterus
- Ectopic pregnancy: this occurs when the fertilized egg implants outside of the uterus (usually in the fallopian tube); it is not a viable pregnancy and can be life-threatening
- Molar pregnancy: this is an abnormal pregnancy that results in an empty fertilized egg (which means there is no embryo) or a fetus that has severe defects
- Blighted ovum: the fertilized egg implants into the lining of the uterus but does not turn into an embryo (this leads to having an empty pregnancy sac)
There are also different stages of loss:
- Threatened miscarriage: a pregnant woman experiences light bleeding but could still go on to have a healthy pregnancy
- Inevitable miscarriage: a miscarriage will happen soon—usually after light to heavy vaginal bleeding begins
- Incomplete miscarriage: some fetal tissue and products of conception has passed but some fetal tissue remains in the uterus
- Complete miscarriage: all of the pregnancy tissue and products of conception fully clear the uterus
- Missed miscarriages are losses that go unnoticed (usually before 12 weeks gestation).
- If you think you are having a missed miscarriage, call your doctor. They can do an exam to see if you have had a missed abortion or other pregnancy complications.
- What causes a missed miscarriage isn’t always clear. Often it is due to chromosomal abnormalities. It is not your fault!
- If you experience a loss, take time to grieve and get the support you need.
- You can still get pregnant in the future after having a missed miscarriage.
- Any type of pregnancy loss can cause stress and grief. Understanding and managing a missed miscarriage is more about your body and your options to regain a sense of control. In case no one has told you recently, you are so strong.